POS0753 PROSPECTIVE EVALUATION OF HEALTH-RELATED QUALITY OF LIFE (HRQoL) IN A MONOCENTRIC COHORT OF PATIENTS WITH LONGSTANDING SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
Authors: E. Elefante, C. Tani, V. Signorini, C. Stagnaro, D. Zucchi, F. Trentin, L. Carli, F. Ferro, M. Mosca
Journal: Annals of the Rheumatic Diseases (2022)

Background The optimization of HRQoL in SLE patients is defined as one of the treatment goals in the 2019 EULAR recommendations 1 for the management of SLE. Most studies have examined HRQoL at one point in time, while the few longitudinal studies do not report a clear variation in Patient Reported Outcomes (PROs) with respect to changes in disease activity. It would be important to understand if, even in a real-life setting, the improvement of patients’ HRQoL may represent an achievable target. Objectives the aim of this study was to analyze HRQoL over time in a monocentric cohort of patients with SLE and investigate which disease-related factors determine short-term variation of HRQoL in a real-life setting. Methods this is a longitudinal, prospective monocentric study which included consecutive adult outpatients with SLE (1997 ACR classification criteria), regularly followed at the Rheumatology Unit of Pisa. Patients were enrolled over a period of 2 years, before the pandemic outbreak, and had at least 2 assessments per year. For each patient, demographics, comorbidities, treatment, clinical and laboratory data were collected. Disease activity was evaluated with the SELENA-SLEDAI and organ damage with the SLICC/DI. We defined as a significant variation of disease activity, a difference of clinical SELENA-SLEDAI ≥ 4 points between 2 subsequent evaluations. At each visit, patients completed the following PROs: SF-36, FACIT-Fatigue and LIT. Results we enrolled 210 consecutive SLE patients, mainly female (93.8%) and of Caucasian ethnicity (97.1%), with a mean age at enrollment of 45.1±12.7 years and a median disease duration of 13 years (IQR 5-21). At baseline, the median SLEDAI of the cohort was 2 (IQR 0-4). The most frequent active disease manifestations were: articular (17.1%) and hematological (15.2%); 6.7% of patients had active renal disease. 47.14% had a SLICC-DI &gt; 0 with a median SLICC-DI among them of 2 (IQR 1-3). 11.43% of patients had a concomitant fibromyalgia. Most patients were on Hydroxychloroquine (78.1%) and low dose glucocorticoid (55.2%), with a median daily dose of 2 mg (IQR 0-4) of prednisone equivalent; 41.4% were on conventional immunosuppressants and 11.9% on biologics, mainly belimumab. The median scores of PROs at enrollment are reported in Table 1. At baseline, fibromyalgia confirmed to have a significant negative impact on all PROs after adjustment for confounding factors ( p &lt;0.05). Each patient underwent two consecutive evaluations, with a median interval between them of 11.4 months. We observed a significant variation of disease activity in 36/210 patients (17.14%). Then, we compared the subgroup of patients with unchanged disease activity with that of patients who showed a significant variation of disease activity. We found that FACIT and LIT scores didn’t change over time in both subgroups, whereas PCS ( p &lt;0.001) and MCS ( p &lt;0.01) scores of the SF-36 showed a significant variation in both groups, between the first and the second clinical assessment. However, in the subgroup of patients with a significant change of disease activity, the variation of PCS and MCS was not correlated with the variation of disease activity or ongoing treatment. In particular, patients with a significant improvement of HRQoL over time didn’t have a corresponding significant reduction of the SLEDAI score or of the daily glucocorticoid dose. Table 1. PROs scores at baseline. PROs Median scores at baseline SF-36 PCS 58 (IQR 49.09- 68) SF-36 MCS 57 (IQR 46.42-67) FACIT 42 (IQR 32-46) LIT 20 (IQR 7.5-40) Conclusion our findings seem to suggest that HRQoL over time in outpatients with longstanding SLE tends to be stable (maybe because patients are able to adapt to their illness) or varies unpredictably, maybe influenced by not disease-related factors. Further studies are needed to better understand which factors influence HRQoL over time and which questionnaires are more sensitive to catch its variation. References [1]PMID: 30926722 Disclosure of Interests None declared